Daniel Taylor and Dawn Goodwin present a case study of the Morecambe Bay Inquiry (MBI), which examined the high rate of maternal and neonatal deaths over a period of 9 years (2004–2013), within the small maternity unit of Furness General Hospital (FGH), one of the three hospitals comprising Morecambe Bay Hospitals Trust.1 They examine this through a conceptual lens, and provide a solution involving changes in medical education. This commentary explores both these elements. First, they use the lens of ‘Normalisation (...) of Deviance’ (NoD) to explain organisational failure. However, other available lenses such as ‘Sociology of Disasters’, ‘Organisational Silence’ and ‘Comfort-seeking Behaviour’ may point to different problems and solutions. More justification for their choice of the lens of NoD would have been useful. Similarly, more justification for their focus on a cluster of five ‘serious untoward incidents’ (SUIs) occurring in 2008 would also have been useful. They suggest that before 2008, the perinatal mortality rate was low, patient satisfaction was high and recent level 2 accreditation of maternity services by the Clinical Negligence Scheme for Trusts all suggested standards of care within the obstetric department were adequate. This stream of positive signals is likely to have contributed towards a genuine belief of safe operation within the maternity unit by staff and board members. However, as they acknowledge, the first problem can be seen in 2004. According to the MBI,2 there were SUIs in the years before and after 2008, but this …. (shrink)

We thank the commentators for their thoughtful engagement with our paper.1 In different ways, they make the same substantial point: our suggested interventions are not enough to solve the problems of organisational failure. On this we wholeheartedly agree. Organisational failure in healthcare is complex and multifaceted, it cannot be solved by one intervention in medical education. We did not intend to imply that our proposals alone would solve organisational failure, and this positioning misconstrues the aims of our paper. We had (...) more modest ambitions, we wanted to shift the analytical emphasis away from the individual and explore the implications raised by our analysis for our piece of the jigsaw—medical education. Having stepped away from such grand claims, the commentators make some valid points to which we would like to respond more specifically. Jesudason makes the distinction that normalisation of deviance (NoD) is well suited to understand institutional misfeasance but not malfeasance.2 We are inclined to agree; NoD can do some things but not all. Likewise, …. (shrink)